UNOS Policy:Â ABO incompatible HTX for children up to 2 years (with acceptable isohaemoglutinin titres – less than 1:4)
Recipient | Donor compatible | Donor incompatible | Antibodies to avoid | Plasma / Platelets | RBC |
0 | 0 | 0 | |||
0 | AB | Anti AAnti B | AB | 0 | |
0 | A | Anti A | AB or A | 0 | |
0 | B | Anti B | AB or B | 0 | |
A | A | ||||
A | 0 | ||||
A | AB | Anti AAnti B | AB | A or 0 | |
A | B | Anti AAnti B | AB | A or 0 | |
B | B | ||||
B | 0 | ||||
B | AB | Anti AAnti B | AB | B or 0 | |
B | A | Anti AAnti B | AB | B or 0 | |
AB | AB | AB | |||
AB | A | AB | |||
AB | B | AB | |||
AB | 0 | AB |
Preoperative preparation:
Isohaemagglutinin titres. Avoid transfusion. Consider transfusion in regards to guide.
Perioperative management:
If elevated iso-titre: plasma exchange once on CPB, iso-haemagglutinin quick test before AoCx release, repeat plasma exchange as required.
Postoperative management:
Isohaemaggluttinin titres daily of ABOi HTX. Repeat plasma exchange if required.
Outcome:
Similar long term outcome. Reduced rate of infection and rejection compared to ABO compatible blood transfusions.
References:
[1] Paediatric Heart Transplant Society: www.uab.edu/phts/
[2] Heart Lung Transplant. 2012 Feb;31(2):173-9: Henderson et al: ABO-incompatible heart transplantation: analysis of the Pediatric Heart Transplant Study (PHTS) database.
All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or Android. A list of contributors can be seen here.